Repetitive transcranial magnetic stimulation as an adjuvant method in the treatment of depression: Preliminary results

Abstract

Introduction Repetitive transcranial magnetic stimulation (rTMS) is a method of brain stimulation which is increasingly used in both clinical practice and research. Up-to-date studies have pointed out a potential antidepressive effect of rTMS, but definitive superiority over placebo has not yet been confirmed. Objective The aim of the study was to examine the effect of rTMS as an adjuvant treatment with antidepressants during 18 weeks of evaluation starting from the initial application of the protocol. Methods Four patients with the diagnosis of moderate/severe major depression were included in the study. The protocol involved 2000 stimuli per day (rTMS frequency of 10 Hz, intensity of 120% motor threshold) administered over the left dorsolateral prefrontal cortex (DLPFC) for 15 days. Subjective and objective depressive symptoms were measured before the initiation of rTMS and repeatedly evaluated at week 3, 6, 12 and 18 from the beginning of the stimulation. Results After completion of rTMS protocol two patients demonstrated a reduction of depressive symptoms that was sustained throughout the 15-week follow-up period. One patient showed a tendency of remission during the first 12 weeks of the study, but relapsed in week 18. One patient showed no significant symptom reduction at any point of follow-up. Conclusion Preliminary findings suggest that rTMS has a good tolerability and can be efficient in accelerating the effect of antidepressants, particularly in individuals with shorter duration of depressive episodes and moderate symptom severity.

Repetitivna transkranijalna magnetna stimulacija (rTMS) je metoda moždane stimulacije koja se sve češće primenjuje u kliničkom i istraživačkom radu. Dosadašnja istraživanja su ukazala na moguće antidepresivno dejstvo rTMS, ali jasna nadmoćnost ove metode u odnosu na placebo još nije potvrđena. Cilj rada Cilj rada je bilo praćenje efekta rTMS kao adjuvantnog tretmana antidepresivima na jačinu depresivnosti tokom 18 nedelja primene protokola stimulacije. Metode rada Četiri bolesnika sa dijagnozom umerenog, odnosno teškog depresivnog poremećaja bila su uključena u studiju. Protokol je podrazumevao primenu 2.000 stimulacija na dan tokom 15 dana sa frekvencijom rTMS od 10 Hz, intenziteta 120% motornog praga, nad levim dorzolateralnim prefrontalnim korteksom. Subjektivni i objektivni simptomi depresije ocenjeni su pre početka primene rTMS i ponovo procenjeni u 3, 6, 12. i 18. nedelji od početka stimulacije. Rezultati Kod dva ispitanika je po završetku protokola rTMS uočeno povlačenje simptoma depresije koje se održalo tokom čitavog perioda nadgledanja. Kod jedne ispitanice zapažena je tendencija uspostavljanja remisije u prvih 12. nedelja kliničkog praćenja, ali je u 18. nedelji došlo do pojačanja simptoma depresije. Kod druge ispitanice nije zapaženo značajnije smanjenje simptoma depresije ni u jednom trenutku kliničkog praćenja. Zaključak Preliminarni rezultati ukazuju na dobru podnošljivost rTMS i efikasnost u pojačavanju delovanja antidepresiva, i to najpre kod epizoda depresije koje kraće traju i čiji su simptomi umerenog intenziteta.